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CrossFit Deviant

PARQ & Waiver Sheet

INFORMED CONSENT/ASSUMPTION OF RISK

I agree to participate in one or more physical fitness program(s)/class(es) sponsored by CrossFit Deviant which may include, but not necessarily be limited to, Cross Fit Training, and/or training of any kind by any affiliate, subsidiary or partnership of CrossFit Deviant. CrossFit Deviant has made me fully aware that the fitness programs/classes which CrossFit Deviant offers and in which I desire to participate are of a nature and kind that are extremely strenuous and can/may push me to the limits of my physical abilities.  I the undersigned recognize and understand that the programs/classes are not without varying degrees of risk which may include, but are not limited to the following:

Injury to the musculoskeletal and/or cardio respiratory systems which can result in serious injury or death, injury or death due to negligence on the part of myself, my training partner, or other people around me, injury or death due to improper use or failure of equipment, or injury or death due to a medical condition, whether known or unknown by me. I am aware that any of these above mentioned risks may result in serious injury or death to myself and or my partner(s).

I willingly assume full responsibility for any and all risks that I am exposing myself to as a result of my participation in CrossFit Deviant programs/classes and accept full responsibility for any injury or death that may result from participation in any activity, class or physical fitness program.  I herby certify that I know of no medical problems that would increase my risk of illness and injury as a result of participation in a fitness program designed by CrossFit Deviant. CrossFit Deviant informed me that there exists the possibility of adverse physical changes during an exercise program, and I fully understand the same. CrossFit Deviant informed me that these changes could include abnormal blood pressure, fainting, disorder of heart rhythm, stroke, and in very rare instances, heart attack or even death, and I fully understand the same.  With my full understanding of the above information, I agree to assume any and all risk associated with my participation in the CrossFit Deviant fitness programs/classes.

Covid-19: Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact and proximity. As a result the Government, governing bodies (UK active) and health agencies recommend social distancing and have set out guidlines to be followed.
CrossFit Deviant has put in place preventative measures to reduce the spread of COVID-19; however, CrossFit Deviant cannot guarantee that you or your child(ren) will not become infected with COVID-19. Furthermore, attending CrossFit Deviant could increase your risk and your child(ren)’s risk of contracting COVID-19.
By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that you may be exposed to or infected by COVID-19 by attending CrossFit Deviant and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at CrossFit Deviant may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Coaches, volunteers, other program participants and their families.
I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my attendance at the CrossFit Deviant. 

Release: 

In full consideration of the above mentioned risks and hazards and in full consideration of the fact that I am willingly and voluntarily participating in the activities made available by CrossFit Deviant, and with my full understanding of all of the above, I hereby waive, release, remise and discharge CrossFit Deviant and its agents, officers, principals and employees and volunteers, of any and all liability, claims, demands, actions or rights of action, or damages of any kind related to, arising from, or in any way connected with, my participation in the CrossFit Deviant fitness programs/classes, including those allegedly attributed to the negligent  acts or omissions of the above mentioned parties.

This agreement shall be binding upon me, my successors, representatives, heirs, executors, assigns, or transferees.  If any portion of this agreement is held invalid, I agree that the remainder of the agreement shall remain in full legal force and effect.

If I am signing on behalf of a minor child, I also give full permission for any person connected with CrossFit Deviant to administer first aid deemed necessary, and in case of serious illness or injury, I give permission to call for medical and or surgical care for the child and to transport the child to a medical facility deemed necessary for the well being of the child.

Indemnification: I recognise that there is risk involved in the types of activities offered by CrossFit Deviant. Therefore I accept financial responsibility for any injury that I or the participant may cause either to him/herself or to any other participant due to his/her negligence. Should the above mentioned parties, or anyone acting on their behalf, be required to incur attorney’s fees and costs to enforce this agreement, I agree to reimburse them for such fees and costs. I further agree to indemnify and hold harmless CrossFit Deviant, their principals, agents, employees, and volunteers from liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while participating in activities offered by CrossFit Deviant. 

Use of picture(s)/film/likeness:  I agree to allow CrossFit Deviant, its agents, officers, principals, employees and volunteers the a picture(s), film and/or likeness of me for advertising purposes.  In the event I choose not to allow the use of the same for said purpose, I agree that I must inform CrossFit Deviant of this in writing. 

I have fully read and fully understand the foregoing assumption of risk, and release of liability and I understand that by signing it obligates me to indemnify the parties named for any liability for injury or death of any person and damage to property caused by my negligent or intentional act or omission. I understand that by signing this form I am waiving valuable legal rights.

 

Please select who will be participating...
AdultMinor
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First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
First Participant's Information

Home Phone #

Mobile Phone #
First Participant's Signature*
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Health Assessment


CrossFit Deviant  recommends that you clear your participation in any exercise program with you physician. 


Have you ever had any form of heart disease or Heart problems including a stroke? *
Yes
No

Explain
Have you ever experienced shortness of breath or chest pains? *
Yes
No

Explain
Do you suffer from Low Blood Pressure? *
Yes
No

Explain
Do you suffer from High Blood Pressure? *
Yes
No

Explain
Do you suffer from Diabetes? *
Yes
No

Type
Do you ever suffer from shortness of breath at rest or during mild exercise? *
Yes
No

Explain
Do you suffer from Asthma or any other respiratory complaint?
Yes
No

Explain
Do you have Arthritis or any other joint complaint? *
Yes
No

Where
Do you have High cholesterol? *
Yes
No

Reading
Are you currently on any medication? *
Yes
No

List
Is there any other reason you know of that would stop you from participation in physical exercise? *
Yes
No

Explain
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Home Phone #

Mobile Phone #
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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